CardioExchange Archive

March 1st, 2012

The Growing Number of Observation Stays: How Do You Decide?

Harlan M. Krumholz, MD, SM

The number of observation stays are growing in this country, in part as a response to Medicare audits that are disallowing admissions for some patients – and maybe in part to reduce crowding in the Emergency Medicine Department. The problem is that criteria are not clear, so there is likely a lot of variability across […]

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February 24th, 2012

A Call for Help to Reduce Readmissions

Harlan M. Krumholz, MD, SM

The national focus on readmissions (e.g., Partnership for Patients) has yet to yield improvements in performance. Many clinicians and hospitals are seeking help in their efforts to reduce readmission rates. Hospital to Home, a national quality improvement initiative led by the American College of Cardiology and the Institute for Healthcare Improvement, has posted a list of […]

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February 23rd, 2012

Reality Check: Do 42% of Women with AMI Present Without Chest Pain?

Harlan M. Krumholz, MD, SM

I am reading the new paper from NRMI in JAMA on the association of age and sex with AMI symptom presentation and am struck by the finding that 35% of the patients did not present with chest pain. This percentage is higher than I have seen elsewhere. In our recent studies, spanning many sites, we have […]

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February 15th, 2012

Mortality-Risk Calculators for AMI and Heart Failure Patients

Harlan M. Krumholz, MD, SM

Two mortality-risk calculators ­– one for patients with acute MI and another for those with heart failure – are now available for free at www.mortalityscore.org. The calculators are based on risk models produced by our research group at Yale for the Center for Medicare and Medicaid Services (CMS). The models are derived from Medicare administrative-claims […]

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February 9th, 2012

What Are You Doing About Readmission Rates?

Harlan M. Krumholz, MD, SM

Today there was news that an insurance company may start incorporating incentives about readmission into its contracts. What are you doing about readmission rates at your institution?

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February 2nd, 2012

The Biggest Opportunities for Cost Savings in Cardiology: Take II

Harlan M. Krumholz, MD, SM

Let’s build on the suggestions that the community has made. How do we actually deliver on some on reducing these tests and procedures? What are we still missing?

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January 19th, 2012

Are We Ready to Stop Treating Cholesterol Levels and Start Treating Risk?

Harlan M. Krumholz, MD, SM

With the advent of ATPIV, should we stick with determining treatment based on LDL levels or is time for a new paradigm based on a more nuanced understanding of risk?

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January 9th, 2012

What Are the Biggest Opportunities for Cost Savings in Cardiology?

Harlan M. Krumholz, MD, SM

Tell us the one test or procedure that you think should be carefully examined to make the biggest dent on waste in cardiac care.

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January 4th, 2012

Missing Data: The Elephant That’s Not in the Room

Harlan M. Krumholz, MD, SM

There is a problem so grave that it threatens the very validity of what we learn from the medical literature. Bad data? Not exactly. Actually, it’s missing data — information, relevant to the risks and benefits of treatments, that is simply not published. In some cases, these data would make a critical difference in the […]

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January 3rd, 2012

Missing Data: The Elephant That’s Not in the Room

Harlan M. Krumholz, MD, SM

There is a problem so grave that it threatens the very validity of what we learn from the medical literature. Bad data? Not exactly. Actually, it’s missing data — information, relevant to the risks and benefits of treatments, that is simply not published. In some cases, these data would make a critical difference in the […]

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